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Pang EM, Kreimer SR, Cohen HJ, Fisher J. "My Home Away From Home": Community Support for International Pediatric and Young Adult Patients and Their Families in End-of-Life Care and Bereavement. J Palliat Med 2024; 27:959-963. [PMID: 37856163 DOI: 10.1089/jpm.2023.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Background: Foreign national patients and families can face life-limiting illness and end-of-life care far from home; this palliative need has not been well described. Case Description: We present a case of a 20-year-old Ugandan patient diagnosed with metastatic alveolar rhabdomyosarcoma who presented to a pediatric academic medical center in California. Despite treatment, her disease progressed and she was unable to return to Uganda due to symptom burden. The patient and her family met regularly with palliative care during their hospital stay; the palliative approach included cross-cultural sharing, connecting across differences, and fostering community. The family additionally cultivated a support system within the hospital and local African communities. This was illustrated in the memory album the patient created, and in her family's extensive bereavement support. Conclusions: This case explores opportunities for individualized psychosocial care and community-based support to enhance palliative care for foreign national patients and families.
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Affiliation(s)
- Emily M Pang
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA
| | - Sara R Kreimer
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Stanford University & Lucile Salter Packard Children's Hospital at Stanford, Stanford, California, USA
| | - Harvey J Cohen
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Stanford University & Lucile Salter Packard Children's Hospital at Stanford, Stanford, California, USA
| | - Joan Fisher
- Division of Pediatric Hematology Oncology, Department of Pediatrics, Stanford University & Lucile Salter Packard Children's Hospital at Stanford, Stanford, California, USA
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Salikhanov I, Yuliya S, Aceti M, Schweighoffer R, Kunirova G, Khashagulgova F, Crape BL, Katapodi MC. Challenges of palliative care identified by stakeholders in resource-limited settings: A multi-regional study in Kazakhstan. J Cancer Policy 2024; 40:100474. [PMID: 38513969 DOI: 10.1016/j.jcpo.2024.100474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/12/2024] [Accepted: 03/18/2024] [Indexed: 03/23/2024]
Abstract
INTRODUCTION In Kazakhstan, a country of 19 million residents, more than 100,000 patients need palliative care. Since at least one family member is usually involved in the care of a terminal patient, more than 200,000 people would benefit from high-quality palliative care services in the country. However, with only 45 physicians and 101 nurses attending to 1925 palliative beds, Kazakhstan seeks to develop palliative services that meet the national needs in resource-limited settings and international standards. The objectives of this study are to explore the challenges faced by stakeholders involved in palliative care in Kazakhstan and to subsequently provide recommendations that can guide policymakers towards further developing palliative care services in the country. METHODS This cross-sectional descriptive study collected narrative data with in-depth interviews from n= 29 palliative stakeholders (family caregivers n= 12, healthcare professionals =12, administrators n= 5) across five regions of Kazakhstan. Verbatim transcripts of interviews were analyzed using content analysis to identify needs and challenges of stakeholders involved in palliative care. RESULTS Our analysis identified seven main challenges of palliative care stakeholders: high out-of-pocket expenditures; lack of mobile palliative care services for home-based care; severe shortages of opioids to prevent pain suffering; poor formal palliative care education; absence of practical skills training for family caregivers; lack of awareness about palliative care in the society, and lack of state support. CONCLUSION Implementation of national palliative care strategies and policies require a large-scale coordinated involvement of all stakeholders. Our recommendations are based on the idea that coordinated, targeted, and tailored stakeholder engagement is preferred to a one-size-fits-all strategy.
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Affiliation(s)
- Islam Salikhanov
- University of Basel, Department of Clinical Research, Davidsbodenstrasse 28, Basel 4056, Switzerland.
| | - Savinova Yuliya
- Kostanay City Oncological Multidisciplinary Hospital, Kostanay, Kazakhstan
| | - Monica Aceti
- University of Basel, Department of Clinical Research, Basel, Switzerland
| | - Reka Schweighoffer
- University of Basel, Department of Clinical Research, Basel, Switzerland
| | - Gulnara Kunirova
- President of the Kazakhstan Association of Palliative Care, Almaty, Kazakhstan
| | | | | | - Maria C Katapodi
- University of Basel, Department of Clinical Research, Switzerland
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O'Connor S, Cave L, Philips N. Informing nursing policy: An exploration of digital health research by nurses in England. Int J Med Inform 2024; 185:105381. [PMID: 38402804 DOI: 10.1016/j.ijmedinf.2024.105381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024]
Abstract
AIMS Digital health technologies are designed, implemented, and evaluated to support clinical practice, enable patients to self-manage illness, and further public and global health. Nursing and health policies often emphasise the importance of evidence-based digital health services to deliver better care. However, the contribution nurses make to digital health research in many countries is unknown. Hence, this study aims to examine digital health research conducted by nurses in England. DESIGN A bibliometric analysis. METHODS The CINAHL, MEDLINE, and Scopus databases were searched between 2000 and 2022, and supplemented with a hand search of nurses' research profiles. Results were screened by title, abstract, and full text against eligibility criteria. Data were extracted and bibliometric analysis used to summarise the findings. RESULTS Mental health nurses produced the most digital health research in England, followed by nurses working in community care, with several disciplines underrepresented or missing. Web/online health services or information was the most researched technology, followed by mobile health and telehealth. Nurses based in the south-east and north-west of England produced the most digital health research, with other regions less well represented. CONCLUSION Nurse leaders should support nurses to conduct more digital health research by providing dedicated time, funding, and professional development opportunities, particularly in under researched clinical areas, technologies, and geographic regions to further evidence-based practice and patient care. More digital nursing data is needed to support nurse led research in areas like artificial intelligence and data science. The findings supported the national Philips Ives Review by identifying areas of digital nursing research that need more investment in England.
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Affiliation(s)
- Siobhan O'Connor
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, United Kingdom.
| | - Louise Cave
- NHS England Transformation Directorate, NHS England, United Kingdom.
| | - Natasha Philips
- School of Health & Society, University of Salford, United Kingdom.
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Dilhani WNS, Mitchell S, Dale J, Toor K, Javaid M, MacArtney JI. A mixed-methods systematic review investigating the use of digital health interventions to provide palliative and end-of-life care for patients in low- and middle-income countries. Palliat Care Soc Pract 2024; 18:26323524241236965. [PMID: 38617095 PMCID: PMC11010586 DOI: 10.1177/26323524241236965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 02/15/2024] [Indexed: 04/16/2024] Open
Abstract
Background The need for palliative care is rising globally with 76% of those who are in need living in low- and middle-income countries (LMICs). Digital health interventions (DHIs) have been identified as a means of making palliative care more widely accessible. This review summarizes the range and characteristics of DHIs used to deliver palliative care in LMICs and sought to identify factors that influence their implementation and utilization. Objectives This review aims to summarize the range and characteristics of DHIs used to deliver palliative care in LMICs and identify factors that influence their implementation and utilization. Design Mixed-method systematic review incorporating both quantitative and qualitative data. Data sources and methods All studies focusing on DHIs for patients who need palliative care (adults/children) and their caregivers (patient and caregiver centred) in LMICs and published in English were identified through a systematic search of MEDLINE, EMBASE, PsycINFO and CINAHL databases. Data synthesis and analysis were carried out following the convergent integrated approach based on the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews. Results Fifteen studies were included (three qualitative, four mixed-methods and eight quantitative studies). Telemedicine/mHealth was the most reported DHI utilized in LMICs in delivering palliative care. Patients and caregivers benefited from using DHIs in many ways including increased access to care with reduced discomfort, travel time and risk of health care-associated infections. Health care providers also reported that using DHI such as telemedicine enables them to provide care in a more effective and efficient way. Four factors were identified as the main barriers to implementation: resource constraints; literacy, training and skills; governance, operational and communication issues and technical issues. Conclusion DHIs, such as telemedicine, have the potential to enhance accessibility to palliative care in LMICs, particularly in rural areas. Comprehensive strategies for their use are required to address the identified barriers.
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Affiliation(s)
| | - Sarah Mitchell
- Division of Primary Care, Palliative Care and Public Health, University of Leeds, Leeds, UK
| | - Jeremy Dale
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, UK
| | - Kavanbir Toor
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Mikail Javaid
- Warwick Medical School, University of Warwick, Coventry, UK
| | - John I. MacArtney
- Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Medical School Building, Coventry, West Midlands CV4 7AL, UK
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Hayes Bauer E, Schultz ANØ, Brandt F, Smith AC, Bollig G, Dieperink KB. Patient and families' perspectives on telepalliative care: A systematic integrative review. Palliat Med 2024; 38:42-56. [PMID: 38112009 PMCID: PMC10865769 DOI: 10.1177/02692163231217146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND Telepalliative care is increasingly used in palliative care, but has yet to be examined from a patient and family perspective. A synthesis of evidence may provide knowledge on how to plan and provide telepalliative care that caters specifically to patients and families' needs. OBJECTIVE To synthesise evidence on patients and families' perspectives on telepalliative care. DESIGN A systematic integrative review (PROSPERO #CRD42022301206) reported in accordance with PRISMA 2020 guidelines. Inclusion criteria; primary peer-reviewed studies published 2011-2022, patient and family perspective, >18 years, telepalliative care and English/Danish language. Quality was appraised using the mixed-methods appraisal tool, version 2020. Guided by Toronto and Remington, data were extracted, thematically analysed and synthesised. DATA SOURCES MEDLINE, EMBASE, PsycINFO and CINAHL were searched in March 2022 and updated in February 2023. RESULTS Forty-four studies were included. Analysis revealed five themes; the effect of the Covid-19 pandemic on telepalliative care, adding value for patients and families, synchronous and asynchronous telepalliative care, the integration of telepalliative care with other services and the tailoring and timing of telepalliative care. CONCLUSION Enhanced access to care and convenience, as attributes of telepalliative care, are highly valued. Patients and families have varying needs during the illness trajectory that may be addressed by early integration of telepalliative care based on models of care that are flexible and combine synchronous and asynchronous solutions. Further research should examine telepalliative care in a post-pandemic context, use of models of care and identify meaningful outcome measures from patient and family perspectives for evaluation of telepalliative care.
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Affiliation(s)
- Eithne Hayes Bauer
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Faculty of Health Sciences, Department of Clinical Research, Family Focused Healthcare Research Centre (FaCe), University of Southern Denmark, Odense, Denmark
| | - Anders Nikolai Ørsted Schultz
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Frans Brandt
- Institute of Regional Health Research, Hospital Soenderjylland, University of Southern Denmark, Odense, Denmark
- Department of Internal Medicine, Medical Research Unit, Hospital Soenderjylland, University Hospital of Southern Jutland, Aabenraa, Denmark
| | - Anthony C Smith
- Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
- Faculty of Medicine, Centre for Online Health, The University of Queensland, Australia
| | - Georg Bollig
- HELIOS Klinikum Schleswig, Department of Anesthesiology, Intensive Care, Palliative Medicine and Pain Therapy, Schleswig, Schleswig-Holstein, Germany
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Karin Brochstedt Dieperink
- Faculty of Health Sciences, Department of Clinical Research, Family Focused Healthcare Research Centre (FaCe), University of Southern Denmark, Odense, Denmark
- Department of Oncology, Odense University Hospital, Odense, Denmark
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Salako O, Enyi A, Miesfeldt S, Kabukye JK, Ngoma M, Namisango E, LeBaron V, Sisimayi C, Ebenso B, Lorenz KA, Wang Y, Ryan Wolf J, van den Hurk C, Allsop M. Remote Symptom Monitoring to Enhance the Delivery of Palliative Cancer Care in Low-Resource Settings: Emerging Approaches from Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:7190. [PMID: 38131741 PMCID: PMC10743024 DOI: 10.3390/ijerph20247190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/10/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
This paper brings together researchers, clinicians, technology developers and digital innovators to outline current applications of remote symptom monitoring being developed for palliative cancer care delivery in Africa. We outline three remote symptom monitoring approaches from three countries, highlighting their models of delivery and intended outcomes, and draw on their experiences of implementation to guide further developments and evaluations of this approach for palliative cancer care in the region. Through highlighting these experiences and priority areas for future research, we hope to steer efforts to develop and optimise remote symptom monitoring for palliative cancer care in Africa.
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Affiliation(s)
- Omolola Salako
- Radiation Biology, Radiotherapy and Radiodiagnosis (RBRR) Digital Health Hub, College of Medicine, Lagos University Teaching Hospital, Lagos 102215, Nigeria;
| | | | - Susan Miesfeldt
- Medical Oncology, Maine Medical Center, MaineHealth Cancer Care Center, Scarborough, ME 04106, USA;
| | - Johnblack K. Kabukye
- Uganda Cancer Institute, Upper Mulago Hill Road, Kampala P.O. Box 3935, Uganda;
- Swedish Program for ICT in Developing Regions (SPIDER), Department of Computer and Systems Sciences (DSV), Stockholm University, 164 55 Stockholm, Sweden
| | - Mamsau Ngoma
- Ocean Road Cancer Institute, Dar es Salaam P.O. Box 3592, Tanzania;
| | - Eve Namisango
- African Palliative Care Association, Kampala P.O. Box 72518, Uganda;
| | - Virginia LeBaron
- School of Nursing, University of Virginia, Charlottesville, VA 22903, USA;
| | - Chenjerai Sisimayi
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Johannesburg 2006, South Africa;
| | - Bassey Ebenso
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
| | - Karl A. Lorenz
- Ci2i, United States Department of Veterans Affairs, Menlo Park, CA 94025, USA;
- Primary Care and Population Health, Stanford School of Medicine, Stanford, CA 94305, USA
| | - Yan Wang
- School of Nursing, University of Pittsburgh, Pittsburgh, PA 15213, USA;
| | - Julie Ryan Wolf
- Departments of Dermatology and Radiation Oncology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY 14642, USA;
| | - Corina van den Hurk
- R&D Department, Netherlands Comprehensive Cancer Organisation, 3501 DB Utrecht, The Netherlands;
| | - Matthew Allsop
- School of Medicine, University of Leeds, Leeds LS2 9LU, UK;
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Salikhanov I, Katapodi MC, Kunirova G, Crape BL. Improving palliative care outcomes in remote and rural areas of LMICs through family caregivers: lessons from Kazakhstan. Front Public Health 2023; 11:1186107. [PMID: 37601198 PMCID: PMC10434554 DOI: 10.3389/fpubh.2023.1186107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 07/18/2023] [Indexed: 08/22/2023] Open
Abstract
Approximately 60 million people require palliative care worldwide, and nearly 80% of them live in low- and middle-income countries (LMICs). Providing palliative care in remote and rural areas of LMICs requires special consideration to ensure equitable access to healthcare. This perspective aims to deliver pragmatic, context-oriented policy recommendations designed to improve palliative care outcomes in Kazakhstan by capitalizing on existing resources and considering its unique geopolitical and sociocultural context. With approximately half of the population in Kazakhstan residing in remote and rural regions, the provision of healthcare services - specifically palliative care - mandates particular attention to ensure equal access to high-quality care. To understand challenges of implementing palliative care in remote and rural regions of Kazakhstan and to propose tailored solutions, 29 key stakeholders, including family caregivers, health professionals, and palliative care administrators, were identified in five regions of Kazakhstan. The main challenges encountered by family caregivers include lack of palliative care skills, the need for home-based care from mobile services, and high out-of-pocket expenditures. The challenges highlighted by healthcare providers and administrators were the lack of formal education in palliative care, shortage of opioids, and limited societal awareness and state support. Based on challenges elaborated from stakeholders and existing literature in palliative care and family caregiving, this perspective advocates against replicating the strategies implemented in high-income countries. Family caregivers play a critical role in implementing affordable and efficient palliative care in resource-limited settings. Enhancing their competencies through digital training and increasing access to palliative care services through mobile teams are tailored and localized solutions that address specific challenges in Kazakhstan. It is postulated that these recommendations may find utility in other LMICs, potentially benefiting nearly 48 million individuals who require these services.
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Affiliation(s)
- Islam Salikhanov
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Maria C. Katapodi
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Gulnara Kunirova
- President of the Kazakhstan Association of Palliative Care, Almaty, Kazakhstan
| | - Byron L. Crape
- Nazarbayev University School of Medicine, Nur-Sultan, Kazakhstan
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Namukwaya E, Nabirye E, Dandadzi A, Akeju D, Adejoh S, Namisango E, Nkhoma K, Ebenso B, Allsop MJ. "From the Time You Start With them Until the Lord Calls You": A Qualitative Study on the Experiences and Expectations of People Living with Advanced Cancer Interacting With Palliative Care Services in Uganda, Nigeria and Zimbabwe. J Pain Symptom Manage 2022; 64:588-601. [PMID: 36089175 DOI: 10.1016/j.jpainsymman.2022.08.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 01/04/2023]
Abstract
CONTEXT A challenge facing the provision of palliative care in sub-Saharan Africa is a means of increasing coverage of services whilst maintaining quality. Developing an evidence base that reflects patients' experiences and expectations of palliative care services, the context within which services are provided, and the approaches adopted by services in caring for patients, could facilitate and inform the planning and development of patient-centered and responsive services. OBJECTIVES To explore the experiences and expectations of palliative care for people living with advanced cancer in Nigeria, Uganda, and Zimbabwe. METHODS A secondary qualitative analysis of in-depth interviews with 62 people with advanced cancer in Nigeria, Uganda, and Zimbabwe. Framework approach to thematic analysis of transcripts was adopted, focusing on patients' experiences and expectations when interacting with palliative care services, aligning reporting with the COnsolidated criteria for REporting Qualitative research (COREQ). RESULTS Four main themes were generated from the analysis: 1) Condition and community as drivers of a multidimensional burden when living with advanced cancer; 2) The expectations and endeavors of palliative care to ameliorate the impact of cancer on physical, psychological and basic needs; 3) Processes and preferences for interacting and communicating with palliative care services, and; 4) Restoration of hope in the context of limited resources. CONCLUSION Wide-ranging physical, psychological, social and financial impacts on participants were outlined. These concerns were largely met with compassionate and responsive care in the context of constrained resources. Study findings can inform evolving notions of patient-centred care for serious illnesses in the participating countries.
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Affiliation(s)
| | - Elizabeth Nabirye
- Department of Internal Medicine, Makerere University, Kampala, Uganda
| | - Adlight Dandadzi
- Clinical Trials Research Centre, University of Zimbabwe, Harare, Zimbabwe
| | - David Akeju
- Department of Social Work, University of Lagos, Lagos, Nigeria
| | - Samuel Adejoh
- Department of Social Work, University of Lagos, Lagos, Nigeria
| | - Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Kennedy Nkhoma
- Florence Nightingale Faculty of Nursing Midwifery and Palliative Care, Cicely Saunders Institute, King's College London, London, UK
| | - Bassey Ebenso
- Nuffield Centre for International Health and Development, University of Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, UK.
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Nwosu AC, McGlinchey T, Sanders J, Stanley S, Palfrey J, Lubbers P, Chapman L, Finucane A, Mason S. Identification of Digital Health Priorities for Palliative Care Research: Modified Delphi Study. JMIR Aging 2022; 5:e32075. [PMID: 35311674 PMCID: PMC9090235 DOI: 10.2196/32075] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 11/09/2021] [Accepted: 12/02/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Developments in digital health have the potential to transform the delivery of health and social care to help citizens manage their health. Currently, there is a lack of consensus about digital health research priorities in palliative care and a lack of theories about how these technologies might improve care outcomes. Therefore, it is important for health care leaders to identify innovations to ensure that an increasingly frail population has appropriate access to palliative care services. Consequently, it is important to articulate research priorities as the first step in determining how finite resources should be allocated to a field saturated with rapidly developing innovation. OBJECTIVE The aim of this study is to identify research priority areas for digital health in palliative care. METHODS We selected digital health trends, most relevant to palliative care, from a list of emerging trends reported by a leading institute of quantitative futurists. We conducted 2 rounds of the Delphi questionnaire, followed by a consensus meeting and public engagement workshop to establish a final consensus on research priorities for digital technology in palliative care. We used the views of public representatives to gain their perspectives on the agreed priorities. RESULTS A total of 103 experts (representing 11 countries) participated in the first Delphi round. Of the 103 experts, 55 (53.3%) participated in the second round. The final consensus meetings were attended by 10.7% (11/103) of the experts. We identified 16 priority areas, which involved many applications of technologies, including care for patients and caregivers, self-management and reporting of diseases, education and training, communication, care coordination, and research methodology. We summarized the priority areas into eight topics: big data, mobile devices, telehealth and telemedicine, virtual reality, artificial intelligence, smart home, biotechnology, and digital legacy. CONCLUSIONS The priorities identified in this study represent a wide range of important emerging areas in the fields of digital health, personalized medicine, and data science. Human-centered design and robust governance systems should be considered in future research. It is important that the risks of using these technologies in palliative care are properly addressed to ensure that these tools are used meaningfully, wisely, and safely and do not cause unintentional harm.
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Affiliation(s)
- Amara Callistus Nwosu
- Lancaster Medical School, Lancaster University, Lancaster, United Kingdom
- Marie Curie Hospice Liverpool, Liverpool, United Kingdom
- Liverpool University Hospitals National Health Service Foundation Trust, Liverpool, United Kingdom
| | - Tamsin McGlinchey
- Palliative Care Unit, University of Liverpool, Liverpool, United Kingdom
| | - Justin Sanders
- Dana-Farber Cancer Institute, Boston, MA, United States
- Ariadne Labs, Brigham and Women's Hospital and Harvard T H Chan School of Public Health, Boston, MA, United States
- Harvard Medical School, Harvard University, Boston, MA, United States
| | - Sarah Stanley
- Marie Curie Hospice Liverpool, Liverpool, United Kingdom
| | | | - Patrick Lubbers
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
| | - Laura Chapman
- Marie Curie Hospice Liverpool, Liverpool, United Kingdom
| | - Anne Finucane
- Clinical Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Stephen Mason
- Palliative Care Unit, University of Liverpool, Liverpool, United Kingdom
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Karera MGD, Omar MA, Nabirye E, Namukwaya E, Allsop MJ. Mobile Technologies for Palliative Cancer Care in Uganda: Qualitative Secondary Analysis of Health Professional Perspectives. HEALTH POLICY AND TECHNOLOGY 2022. [DOI: 10.1016/j.hlpt.2022.100608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chute C, French T, Raman S, Bradley J. User Requirements for Co-Managed Digital Health & Care (Preprint). J Med Internet Res 2021; 24:e35337. [PMID: 35687379 PMCID: PMC9233266 DOI: 10.2196/35337] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 03/02/2022] [Accepted: 05/08/2022] [Indexed: 11/20/2022] Open
Abstract
Background The sustainability of health and social care has led to an imperative to shift the balance of care to communities and support person-centered, integrated, preventive, comanaged, and sustainable care. The digital tool set can support this shift; however, it must extend beyond a clinical focus to include broader personal, social, and environmental needs, experiences, and outcomes. The existing digital health and care design and user requirements literature focuses mainly on specific digital products or design methods. There is little whole-system or whole-of-life consideration, which is crucial to enacting more significant transformations that span different groups and domains. Objective This study aimed to present a set of recurring user requirements and themes for comanaged digital health and care services derived from the body of co-design projects within a digital health and care program. This study aimed to enable people and organizations looking to reorient their approach to health and care research and delivery from a system-led and condition-specific approach to a more person-centric, whole-of-life model. Methods Participatory design formed the core methodological approach in underlying the design research, from which user requirements were derived. The process of surfacing requirements involved a selection framework for the identification of eligible projects and a structured review process to consolidate user requirements. Results This paper presents a set of 14 common user requirements that resulted from a review of co-design projects. The findings demonstrate overlapping and reinforcing sets of needs from citizens and care professionals related to how data are comanaged to improve care and outcomes. This paper discusses the alignment, contrasts, and gaps with broader, comparable literature. It highlights consensus around requirements for personal health storytelling, sharing data on care experiences and how this can support personalized guidance, visualize trends to support decision-making, and generally improve dialog between a citizen and care professionals. These findings identify gaps around how groups and networks of people engage, posing difficult questions for people designing support services as some of the user requirements are not easily met by organizations operating in silos. Conclusions This study proposes future recommendations for citizens as active, informed, and consenting partners using new forms of privacy-preserving digital infrastructure that puts the citizen in firm control. It is also recommended that these findings be used by people developing new digital services to ensure that they can start with knowledge of the broader user requirement context. This should inform domain-specific research and development questions and processes. Further work is needed to extend these common requirements to more explicitly consider the trust framework required when citizens comanage their data and care across a broad range of formal and informal actors. Consideration of how authority, delegation, and trust function between members of the public will be critical.
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Affiliation(s)
- Chaloner Chute
- The Digital Health & Care Innovation Centre, University of Strathclyde, Glasgow, United Kingdom
| | - Tara French
- The Glasgow School of Art, Forres, United Kingdom
| | - Sneha Raman
- The Glasgow School of Art, Forres, United Kingdom
| | - Jay Bradley
- The Glasgow School of Art, Forres, United Kingdom
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Ebneter AS, Fliedner M, Trapp D, Ramseier F, Sauter TC, Eychmüller S. [Telemedicine in Palliative Care: Digital Communication in a Relationship-Based Speciality - Does It Make Sense?]. PRAXIS 2021; 110:845-850. [PMID: 34814716 DOI: 10.1024/1661-8157/a003781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Telemedicine in Palliative Care: Digital Communication in a Relationship-Based Speciality - Does It Make Sense? Abstract. Telemedicine in palliative care is established especially in countries with large geographical distances. Digital forms of communication (virtual consultations) are most frequently used and well-accepted by patients and caregivers. The main benefit lies in the reduction of the access barrier in the outpatient setting. Advantages are stress reduction for patients (travel, accessibility) and reduction in the care burden for relatives. Additional benefits compared to the physical visit for symptom-control, quality of life and costs are unclear. Risks are influenced by the lack of physical interaction and data security. To what extent telepalliative care makes sense in a high-density health system is difficult to predict. It is therefore important to use these new tools in a carefully adapted and scientifically verified way.
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Affiliation(s)
| | - Monica Fliedner
- Universitäres Zentrum für Palliative Care, Inselspital, Bern
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Mills J, Fox J, Damarell R, Tieman J, Yates P. Palliative care providers' use of digital health and perspectives on technological innovation: a national study. BMC Palliat Care 2021; 20:124. [PMID: 34364379 PMCID: PMC8349145 DOI: 10.1186/s12904-021-00822-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background While the need for digital health capability and technological innovation in palliative care services is growing rapidly, relatively little is known about the current uptake and views of individual palliative care practitioners. This study aims to explore palliative care practitioners’ current use of and perspectives on digital health innovation in palliative care. Methods A descriptive cross-sectional survey with a web-based questionnaire was used. Participants were multidisciplinary palliative care practitioners in Australia. Results Surveys were returned by 170 medical, nursing, and allied health practitioners working in palliative care. Most respondents reported using a variety of digital health technology associated with clinical information systems, mobile devices, SMS text messaging, teleconferencing, and Wi-Fi. These technologies were used for the purpose of communicating with other health professionals, accessing web-based or mobile health palliative care resources, collecting or managing patient data, and providing information or education. However, few reported electronic access to patients’ advance care planning documentation or could update these data. Respondents were moderately confident in their ability to use digital health, held positive beliefs that palliative care could be enhanced through digital health, and were generally supportive of ongoing innovation through digitally-enable models of care. Palliative care providers would most like to see digital health innovations in the areas of client health records, telehealth, and personal health tracking. Conclusion This is the first national study of digital health in Australian palliative care providers. It contributes new knowledge in this important area of palliative care practice to guide policy and education, whilst informing future directions for research.
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Affiliation(s)
- Jason Mills
- Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, 4061, Australia
| | - Jennifer Fox
- Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, 4061, Australia.
| | - Raechel Damarell
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jennifer Tieman
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Patsy Yates
- Centre for Healthcare Transformation, Queensland University of Technology, Kelvin Grove, QLD, 4061, Australia
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Namisango E, Ramsey L, Dandadzi A, Okunade K, Ebenso B, Allsop MJ. Data and information needs of policymakers for palliative cancer care: a multi-country qualitative study. BMC Med Inform Decis Mak 2021; 21:189. [PMID: 34130668 PMCID: PMC8204555 DOI: 10.1186/s12911-021-01555-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/01/2021] [Indexed: 11/05/2022] Open
Abstract
Background Despite regional efforts to address concerns regarding the burden of advanced cancer in Africa, urgent attention is still required. Widespread issues include late symptom presentation, inaccessibility of palliative care services, limited resources, poor data quality, disparity in data availability, and lack of stakeholder engagement. One way of helping to address these issues is by understanding and meeting the data and information needs of policymakers in palliative cancer care. Aims To explore the views of policymakers regarding data availability, data gaps and preferred data formats to support policy and decision making for palliative cancer care in Nigeria, Uganda and Zimbabwe. Methods A secondary analysis of interview data collected as part of a cross-sectional qualitative study that aimed to explore the data and information needs of patients, policymakers and caregivers in Nigeria, Uganda and Zimbabwe. Framework analysis, guided by the MEASURE evaluation framework, was used to qualitatively analyse the data. Results Twenty-six policymakers were recruited. The policymakers data and information concerns are aligned to the MEASURE evaluation framework of data and information use and include; assessing and improving data use (e.g. low prioritisation of cancer); identifying and engaging the data user (e.g. data processes); improving data quality (e.g. manual data collection processes); improving data availability (e.g. the accessibility of data); identifying information needs (e.g. what is ‘need to know’?); capacity building in core competencies (e.g. skills gaps); strengthening organisational data demand and use (e.g. policy frameworks); monitoring, evaluating and communicating of data demand and use (e.g. trustworthiness of data). Conclusions We present evidence of data sources, challenges to their access and use, guidance on data needs for policymakers, and opportunities for better engagement between data producers, brokers and users. This framework of evidence should inform the development of strategies to improve data access and use for policy and decision making to improve palliative cancer services in participating countries with relevance to the wider region.
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Affiliation(s)
- Eve Namisango
- African Palliative Care Association, Kampala, Uganda
| | - Lauren Ramsey
- Bradford Institute for Health Research, Bradford, UK
| | - Adlight Dandadzi
- University of Zimbabwe-Clinical Trials Research Centre ZW, Harare, Zimbabwe
| | | | - Bassey Ebenso
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
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